It's my biannual rant regarding restraints. The regulations regarding what to chart, how often, and what must be addressed are ridiculous for those of us who work in Critical Care areas. So let's roll............and then one follow-up, Coup de Grace.

Extremity Management

By now it's the 21st century
And clearly time to revise an old term,
Regarding a particular topic
That causes some people to squirm
If you're a nurse in the hospital arena
You will know what I'm talking about,
Regarding, the rambunctious patient
Whose mental acuity is in doubt.

For the safety of the patient in question
There are times we must secure foot or hand,
Perhaps they are climbing out of bed
Without a lick of a chance that they can stand,
They may not remember the surgery
The amputation, of five necrotic toes,
They'll leap out of bed like a revived Fred Astaire
And go crashing to the floor; so it goes.

Such an outlandish occurrence as identified
Demands mountains of details in writing,
Old Gimpy, on the floor, has just busted his hip
And his family and I, are now fighting,
They were the ones, in the first place
Who were outraged, when we tied Poppa down,
When we complied with their wishes, and released him
He just figured he’d go dancing downtown.

We’re sued when we do, and screwed when we don’t
Any injuries will be blamed on the Nurse,
Thus I believe, it’s time to toss out the word
The terminology, “restraint” is a curse,
I’ve researched for hours and interviewed for more
And I think I have found the solution,
We need to obscure, the description of our actions
And resolve it with a binding resolution.

I recognize the value of convoluted terms
That were popularized in the business domain,
With an acumen for language, I believe I found the answer
“Extremity Management”, will be the name of the game,
An umbrella of sorts, for a variety of methods
To achieve the best outcome, over time,
Securing, old rambunctious Roberto in bed
And never to be sued for a dime.

We won’t be required to document
The same, silly details each hour,
I’m telling you, that’s such a waste of our time
A guaranteed drain of Nursing power,
We’ll Implement “Extremity Management”
The latest, hot care-plan in town,
With a protocol like that, I can chart in nothing flat
Forcing the Joint Commission to back down.

Fibril_late;
8/11/09
_ _ _ _ _ _ _ _ _ _ _ _ _

Coup de Grace

Extremity Management is my coup de grace
In the face of excessive regulation,
The protocols in practice, regarding Restraints
Are a conglomerate of nonsensical information ,
Foisted upon us by unreasonable voices
Claiming human, and animal rights,
They don’t have a clue to what happens
When Billy-Bob goes bonkers each night;

His Nurse won’t be found at his bedside
With continuous attention for hours,
She has to attend to her other 9 patients
For their meals, dressing changes and showers,
Upper management won’t find us a “Sitter”
A lowly-paid person to watch Billy,
After all, they would have to pay benefits
And for minimum wage, that is silly.

Now sealing our fate, like a 500 pound weight
Are the regulations regarding restraint,
And the all-seeing eyes, of the management guys
Want a guarantee, there's no legal complaint,
While the Nurse on the street
Spends 12 hours on her feet
Walking miles to appease every master,
When old Billy gets loose
He is one wild goose,
And his condition deteriorates that much faster.

I chart every two-hours
So much that it sours
I mark the same boxes each time,
On my 12 hour night
Billy remains snug and tight
In the morning, he's still alive
Is that a crime?

Some officials might claim
I have doctored the game
To tie down the patient, for convenience,
If Billy falls out of bed
Busting a hip and his head
I am sure a court of law, will show no lenience.

So, I tie when I can
If escape is his plan
Don't look to me
For psycho-social recommending,
Patient safety is my mission
And I'll hook him like I'm fishin'
I've got 12-hours to keep him alive
And that's my ending.

Fibril_late;
8/16/09